Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is commonly used as an adjunct to resuscitation and bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It has also been performed for patients with neurogenic shock to support the central aortic pressure necessary for cerebral, coronary and spinal cord perfusion. Although volume replacement and vasopressors are the cornerstones of the management of neurogenic shock, we believe that a REBOA can be used as an adjunct in carefully selected cases to prevent prolonged hypotension and the risk of further anoxic spinal cord injury. This manuscript aims to propose a new damage control algorithmic approach to refractory neurogenic shock that includes the use of a REBOA in Zone 3. There are still unanswered questions on spinal cord perfusion and functional outcomes using a REBOA in Zone 3 in trauma patients with refractory neurogenic shock. However, we believe that its use in these case scenarios can be beneficial to the overall outcome of these patients.

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Improvement of hand functions of spinal cord injury patients with electromyography-driven hand exoskeleton: A feasibility study

Wearable Technologies ◽

10.1017/wtc.2020.9 ◽

2020 ◽

Vol 1 ◽

Author(s):

Youngmok Yun ◽

Youngjin Na ◽

Paria Esmatloo ◽

Sarah Dancausse ◽

Alfredo Serrato ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Degrees Of Freedom ◽

Standardized Test ◽

Hand Function ◽

Severe Disabilities ◽

Finger Movements ◽

Control Approach ◽

Cord Injury ◽

Hand Exoskeleton

Abstract We have developed a one-of-a-kind hand exoskeleton, called Maestro, which can power finger movements of those surviving severe disabilities to complete daily tasks using compliant joints. In this paper, we present results from an electromyography (EMG) control strategy conducted with spinal cord injury (SCI) patients (C5, C6, and C7) in which the subjects completed daily tasks controlling Maestro with EMG signals from their forearm muscles. With its compliant actuation and its degrees of freedom that match the natural finger movements, Maestro is capable of helping the subjects grasp and manipulate a variety of daily objects (more than 15 from a standardized set). To generate control commands for Maestro, an artificial neural network algorithm was implemented along with a probabilistic control approach to classify and deliver four hand poses robustly with three EMG signals measured from the forearm and palm. Increase in the scores of a standardized test, called the Sollerman hand function test, and enhancement in different aspects of grasping such as strength shows feasibility that Maestro can be capable of improving the hand function of SCI subjects.

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Surgical airway procedures in emergency surgical patients: Results of what has become a back-up procedure

World Journal of Surgery ◽

10.1007/s00268-021-06110-7 ◽

2021 ◽

Author(s):

Gijs J. A. Willinge ◽

Falco Hietbrink ◽

Luke P. H. Leenen

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Outcomes ◽

Cervical Spinal Cord ◽

Cervical Spinal Cord Injury ◽

Surgical Patients ◽

Trauma Patients ◽

Airway Patency ◽

Surgical Tracheostomy ◽

Cord Injury

Abstract Background Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. Methods In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated. Results Forty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need. Conclusions No major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.

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Trauma

Congress of Neurological Surgeons Essent ◽

10.1093/med/9780197534342.003.0005 ◽

2020 ◽

pp. 131-170

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Brain Injuries ◽

Cervical Spinal Cord ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Cord Injury

This chapter discusses traumatic spinal cord and brain injuries. The first three studies review the background and key findings of the third National Acute Spinal Cord Injury Study (NASCIS) trial, examine the efficacy of the Canadian C-Spine Rule in the evaluation of cervical spine injuries in alert and stable trauma patients; and describe the development of the Thoracolumbar Injury Classification and Severity Score (TLICS) classification system. The next two studies assess the effect of early surgical decompression in patients with traumatic cervical spinal cord injury and delineate the role of secondary brain injury in determining patient outcome in severe traumatic brain injury. The following set of four studies evaluates the efficacy of phenytoin in preventing posttraumatic seizures, as well as the efficacy of intracranial pressure monitoring, induction of hypothermia, and decompressive craniectomy for severe traumatic brain injury. The last study, which is of historical value, identifies predictors of outcome in comatose patients with traumatic acute subdural hematoma.

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Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

The American Surgeon ◽

10.1177/000313480707301025 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1035-1038

Author(s):

Ali Salim ◽

Marcus Ottochian ◽

Ryan J. Gertz ◽

Carlos Brown ◽

Kenji Inaba ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Blunt Trauma ◽

Injury Severity ◽

Unit Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Cord Injury ◽

Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

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The Incidence of Neurogenic Shock after Spinal Cord Injury in Patients Admitted to a High-Volume Level I Trauma Center

The American Surgeon ◽

10.1177/000313481207800551 ◽

2012 ◽

Vol 78 (5) ◽

pp. 623-626 ◽

Cited By ~ 3

Author(s):

Jennifer T. Mallek ◽

Kenji Inaba ◽

Bernardino C. Branco ◽

Crystal Ives ◽

Lydia Lam ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Trauma Center ◽

High Volume ◽

Neurogenic Shock ◽

Cord Injury ◽

Volume Level ◽

Level I

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Damage control in the nervous system: beware the immune system in spinal cord injury

Nature Medicine ◽

10.1038/nm0709-736 ◽

2009 ◽

Vol 15 (7) ◽

pp. 736-737 ◽

Cited By ~ 45

Author(s):

Phillip Popovich ◽

Dana McTigue

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Nervous System ◽

Immune System ◽

Damage Control ◽

Cord Injury

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(A313) Role of Physiatrists in Post Disaster Scenarios - Lessons Learned from Pakistan, China and Haiti Earthquakes

Prehospital and Disaster Medicine ◽

10.1017/s1049023x1100330x ◽

2011 ◽

Vol 26 (S1) ◽

pp. s105-s105

Author(s):

F.A. Rathore ◽

C. O'connell ◽

J. Li

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Injuries ◽

Community Integration ◽

Functional Restoration ◽

Lessons Learned ◽

Spinal Trauma ◽

Trauma Patients ◽

Cord Injury ◽

Post Disaster

IntroductionPhysical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.MethodologyAuthors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.ResultsIn these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.ConclusionPhysiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.

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